Provider Demographics
NPI:1992035877
Name:FERMAN, RACHELLE PATRICIA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:PATRICIA
Last Name:FERMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:RACHELLE
Other - Middle Name:PATRICIA
Other - Last Name:LINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 W WACKERLY ST STE 3600
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4714
Mailing Address - Country:US
Mailing Address - Phone:989-631-3570
Mailing Address - Fax:
Practice Address - Street 1:555 W WACKERLY ST STE 3600
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4714
Practice Address - Country:US
Practice Address - Phone:866-625-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992035877Medicaid
MI1992035877Medicaid
P00957449Medicare PIN